Monthly Archives: June 2009

Thank You, Mr. President!

Last night was a special moment for me: I was one of those 164 people representing the “face of America” that was in the East Room of the White House as Charlie Gibson and Dianne Sawyer from ABC News interviewed the President as he answered questions about health care reform.


My bottom line conclusion?  This guy knows his stuff.


You may have already seen the telecast or snippets on the morning shows (if you can get past the lead story about the Governor from South Carolina).  If so, there isn’t much I can add to what you have already heard.  But what I can say is that—aside from the glamour and imposing “presence” of the room itself—I was overwhelmingly impressed with the President’s grasp of the issues and his ability to respond effectively if not always completely to the questions he was asked.


I have been through this before.  I have been “in the room” when political figures address audiences and promote their policies.  And, like you, I watch television from time to time, see the debates, listen to the Sunday morning talk shows, and draw conclusions as to whether I agree or … Continue reading →

Workers Also Count In Reforming Personal Health

I have been in Washington the past several days primarily to participate in a congressional staff briefing on the importance of funding for research and to attend the discussion with the President on ABC’s “Prescription for America” which will air this evening at 10PM EDT. 


But something I saw yesterday really bothered me, and brought me back to reality when it comes to understanding the barriers our country faces in achieving true personal health reform. 


The issue?  The extent of overweight and obesity in this country and its impact on our health and our health care costs.


The moment occurred in my hotel, which was hosting a meeting of a well-known nationwide union.  I don’t know the topic of the meeting, but there were a lot of folks in the hotel, all wearing their shirts with the same logo and message.


When I looked over the crowd I saw something that shook me to my physician core.  These were working people—I suspect many of them hard working people—but the number of them who were overweight and obese was astonishing.  The personal impact of the sight surprised me.  It … Continue reading →

Workplace Solutions: Creating A Culture of Health

I had the opportunity last week to participate in a conference sponsored by the American Cancer Society and others that brought together companies to talk about changing the course of cancer through innovative corporate programs and policies.


The take home message for me was that if we are going to solve the health care crisis in this country, we are going to have to learn about the unique and successful corporate health focused initiatives that are happening all around us.


I have given a lot of thought to our health care system (or should I say non-system) over the years. I came to the conclusion years ago that there are always better ways to do things if only we were able to sift the wheat from the chaff, and move the best ideas forward. There are examples out there, but all too frequently they don’t get much notice.


This conference pointed out that corporate America has not been standing still when it comes to trying to find solutions to improving the health of our country while holding down the incessant spiral of health care costs.


There were numerous examples of program successes presented at the … Continue reading →

CT Colonography and Medicare: Are We The Enemy?

A recent article in the New England Journal of Medicine praising the decision by the Centers for Medicare and Medicaid Services to not cover CT colonography for the prevention and early detection of colon cancer for Medicare patients left me with a great deal of concern—especially since it was written by some of the same people who made the decision in the first place.

I consider myself a fairly reasonable, experienced and tolerant person when it comes to the legislative and regulatory decision-making processes.  You win some, you lose some, you reevaluate and generally you move on to the next issue.  But this time, for me at least, it’s different.

The article, which was published online on May 27, 2009 in the New England Journal of Medicine, reviewed the basis for the decision denying coverage for CT colonography in the Medicare program, an issue I have covered previously in this blog.

Here are the opening paragraphs from that article.  Remember, these are the words of the authors, some of whom had either participated in or wrote the final CMS regulation denying coverage for the test:

“In an unprecedented endorsement of evidence-based medicine, the Centers for Medicare Continue reading →

For The President, Cancer Is Personal

Ok, Ok. I must admit that sitting about 40 or 50 feet from President Obama as he delivered his talk this morning at the annual meeting of the American Medical Association House of Delegates was pretty special (I even have the pictures to prove it).


The talk, surprisingly, included a number of comments about cancer and the importance of health care reform as it related to the treatment of cancer and the impact of cancer on the lives of ordinary people.  The difference here, perhaps, is that this President knew and loved one of those “ordinary people.” That person was his mother.  He used the opportunity of this address to once again remind us of his family’s personal travail trying to pay for her medical care and the impact that had on their lives at a very difficult time.


I must admit that when I heard that the President was coming to Chicago to address the AMA House of Delegates I was a bit surprised.  After all, the House is filled with physicians who are very committed to the care of their patients, but are also very politically savvy.  They are for the most part … Continue reading →

My Kingdom For A Pen: Who Is Kidding Who?

I realized last night while reflecting on the annual meeting of the American Society of Clinical Oncology that concluded yesterday in Orlando that my luggage on the trip home was much lighter than in years past. 


The reason?  New pharmaceutical regulations prohibited the drug companies from giving me “anything of value,” namely pens, bags, calendars or whatever they could come up with to give to me and other attendees at the conference to gain attention for their products.


I must admit that I now feel much more pure than I have in years past, and much less conflicted since I haven’t been able to gather my supply of pens for the coming year.


But there is another side to this story; a story of unintended consequences that has not been told and that may have far reaching implications for clinical practice and even for groups like ours that work to defeat cancer.


If I seem a bit cynical about this, it’s because I am.  While I can’t get a free pen, I have colleagues out there who are paid a lot of money to speak on behalf of these same companies, “consult” for … Continue reading →

Megadatabases: The Future of Cancer Research?

Sometimes research reports are as interesting to me for the story behind the story as much as the actual story itself.  Such is the case with two abstracts presented at the annual meeting of the American Society of Clinical Oncology here in Orlando, which closes today.


The two reports deal with the impact of anti-depressants on the effectiveness of tamoxifen, a drug that has been used for decades in the adjuvant (preventive) treatment of breast cancer after surgery and radiation, as well as for the treatment of breast cancer that has spread to other parts of the body.


But the “story behind the story” is that the research was done through the analysis of large medical data banks, one of which is owned by a public company which happens to be a major prescription benefit manager here in the United States. 


The relatively recent development of these megadatabases will, in my opinion, become something we will see used more and more in health care going forward, hopefully for good purposes.


First, the concept behind the research:


Tamoxifen is a drug which is commonly described as an “anti-estrogen”, and essentially blocks the … Continue reading →

New Hope In Treating Triple Negative Breast Cancer

One of the papers presented during yesterday afternoon’s plenary session at the annual meeting of the American Society of Clinical Oncology (ASCO) captured my attention for a couple of reasons.


The study reported on a new drug code named BSI-201 in a trial where the researchers treated women with a form of breast cancer called “triple negative.”  Triple negative breast cancers (or TNBC) are called that because they don’t have estrogen or progesterone hormone receptors and are negative for a genetic marker called HER2. As a result, they can’t be treated with some of the more successful breast cancer treatments such as hormonal therapy or targeted drugs such as trastuzumab (Herceptin ™),  They tend to occur in younger women and especially in African American women.  Unfortunately, they tend to be more aggressive than other forms of breast cancer.


This new drug acts against something called poly(ADP-ribose) polymerase-1, or PARP-1.  If you think that is a mouthful and don’t understand what it is, don’t feel bad.  Neither do I and neither did much of the audience at yesterday’s presentation.  In fact, this was so new to the doctors in the audience that … Continue reading →